System and method for stabilizing delivered laser energy

ABSTRACT

Systems and methods provide for stabilizing the amount of laser energy delivered to a target from a laser device. Generally, delivered laser energy is measured over multiple laser pulses or over time in the case of a constant wave laser. A decrease is then calculated in the delivered energy, the decrease being caused by accumulation of one or more substances, such as ozone, along the laser beam delivery path due to passage of the laser beam along the path. Using this calculated decrease, a laser device may be adjusted to compensate for the decrease in delivered energy due to the accumulated substance(s), thus stabilizing the amount of energy delivered to the target.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a Divisional of U.S. Ser. No. 11/077,173filed Mar. 9, 2005 (Allowed), which application claims priority fromU.S. Provisional Application No. 60/553,580 filed Mar. 15, 2004; thefull disclosures of which are hereby incorporated by reference in theirentirety for all purposes.

BACKGROUND OF THE INVENTION

The present invention relates generally to laser eye surgery methods andsystems. More specifically, the present invention relates to methods andsystems for stabilizing an amount of laser energy delivered to a target.

Known laser eye procedures generally employ an ultraviolet or infraredlaser to remove a microscopic layer of stromal tissue from the cornea ofthe eye to alter the refractive characteristics of the eye. The laserremoves a selected shape of the corneal tissue, often to correctrefractive errors of the eye. Ultraviolet laser ablation results inphoto-decomposition of the corneal tissue, but generally does not causesignificant thermal damage to adjacent and underlying tissues of theeye. The irradiated molecules are broken into smaller volatile fragmentsphotochemically, directly breaking the intermolecular bonds.

Laser ablation procedures can remove the targeted stroma of the corneato change the cornea's contour for varying purposes, such as forcorrecting myopia, hyperopia, astigmatism, and the like. Control overthe distribution of ablation energy across the cornea may be provided bya variety of systems and methods, including the use of ablatable masks,fixed and moveable apertures, controlled scanning systems, eye movementtracking mechanisms, and the like. In known systems, the laser beamoften comprises a series of discrete pulses of laser light energy, withthe total shape and amount of tissue removed being determined by theshape, size, location, and/or number of a pattern of laser energy pulsesimpinging on the cornea. A variety of algorithms may be used tocalculate the pattern of laser pulses used to reshape the cornea so asto correct a refractive error of the eye. Known systems make use of avariety of forms of lasers and/or laser energy to effect the correction,including infrared lasers, ultraviolet lasers, femtosecond lasers,frequency multiplied solid-state lasers, and the like. Known cornealcorrection treatment methods have generally been successful incorrecting standard vision errors, such as myopia, hyperopia,astigmatism, and the like. By customizing an ablation pattern based onwavefront measurements, it may be possible to correct minor aberrationsto reliably and repeatedly provide visual acuity greater than 20/20.

When laser energy is delivered from a laser energy generating device toa target, as in a laser eye surgery procedure, the energy (typically inthe form of a laser beam) passes along a delivery path. The laser beamtypically follows a path that proceeds through a series of lenses,mirrors and/or other optical elements to focus and/or direct the beambefore it arrives at a patient's eye. As laser energy passes along sucha delivery path, it typically causes one or more substances toaccumulate. The most prevalent and significant substance thataccumulates along a UV laser beam delivery path due to passage of thelaser beam is ozone. The laser beam creates ozone when it passes throughoxygen along the delivery path. Subsequent pulses of the laser beam arethen impeded by the presence of ozone along the path, resulting in areduced amount of energy arriving at the patient's eye with eachsubsequent pulse. The same reduction occurs over time with a constantwave laser. As ozone continues to accumulate, the laser energy arrivingat the eye continues to decrease.

One objective in laser eye surgery is to deliver approximately the sameamount of laser energy to the eye with each pulse of the laser, or ifconstant wave laser energy is used, to deliver a constant amount ofenergy to the eye over time. Currently available systems and techniques,however, do not account for accumulation of substances such as ozonealong the laser beam delivery path, and thus do not provide a constantor stabilized amount of delivered laser energy to the eye. Stabilizeddelivered laser energy would enhance laser eye surgery by providing adesired amount of energy to an eye over multiple laser pulses and overtime to allow for a more precise and accurate laser eye surgeryprocedure.

Therefore, it would be desirable to provide methods and systems forstabilizing an amount of laser energy delivered to an eye during a lasereye surgery procedure. Ideally, such methods and systems compensate forimpedance of a laser beam caused by accumulation of substances, such asozone, along the laser beam delivery path. Also ideally, such methodsand systems could be used to calibrate a laser generating device beforeperforming any laser eye surgery procedures and would not requirefrequent recalibrations. At least some of these objectives will be metby the present invention.

BRIEF SUMMARY OF THE INVENTION

The present invention generally provides methods and systems forenhancing delivery of laser energy to a target by helping to stabilizethe amount of delivered energy. Delivered energy is stabilized bycompensating for one or more accumulated substances, typically ozone,that form when a laser beam travels along its path from a lasergenerating device to a target. Once a reduction in delivered energy dueto accumulated ozone and/or other substances is measured, an adjustmentto a laser generating device may be calculated to compensate for thereduction in delivered energy. Although methods and systems of theinvention are typically described for use in laser eye surgery, variousembodiments may be used for stabilizing delivered laser energy for anyother purpose, with any other laser device or the like. Thus, thepresent invention is not limited to use in laser eye surgery proceduresor any other specific field.

In the following description, the terms “delivered energy” or “deliveredlaser energy” are often used. By delivered energy it is meant the energythat is delivered to a target, such as a patient's eye. In other words,delivered energy is the energy that actually arrives at the target. Anamount of delivered energy may or may not be different than an amount of“provided laser energy,” “dispatched laser energy,” “sent laser energy,”“energy directed from a laser device” or the like. By provided laserenergy it is meant the energy that leaves a laser device or laser energygenerating device. As is described above, an amount of energy that isprovided by a laser energy generating device is often decreased as ittravels along a laser beam delivery path, thus resulting in a decreasedamount of delivered energy that arrives at the target. Such is the case,for example, when multiple laser beam pulses are directed along thedelivery path. Earlier pulses cause oxygen to be converted to ozone, andthe ozone impedes subsequent laser pulses from traveling along the path,thus reducing the amount of laser energy arriving at the target insubsequent pulses. In other words, if the subsequent pulses have thesame amount of energy as they leave the laser energy generating device,they do not have the same amount of energy when they arrive at thetarget, due to interference from ozone and/or other substancesaccumulated along the delivery path. At any rate, none of theterminology defined above or used in the following descriptions shouldbe interpreted to limit the scope of the invention. Any suitable termsmay be used to describe an amount of laser energy leaving a device andan amount of energy arriving at (or “delivered to”) a target.

That being said, in one aspect of the invention, a method forstabilizing an amount of laser energy delivered to a target by a lasergenerating device involves: measuring the amount of delivered laserenergy arriving at or near a target from the laser generating deviceover a period of time; calculating a decrease in the amount of deliveredenergy over time; and adjusting the laser generating device tocompensate for the decrease to stabilize the amount of delivered laserenergy arriving at the target. In some embodiments, measuring the amountof delivered laser energy comprises measuring with a laser energy meterpositioned at or near the target. For example, the laser energy metermay be positioned on an opposite side of a partially transparent lens ormirror from the target. In some embodiments, the laser energy comprisesmultiple pulses of laser energy, while in other embodiments the energyis constant wave (CW) laser energy.

As discussed above, in some embodiments calculating the decrease in theamount of delivered energy involves calculating a decrease caused bypassage of the laser energy along a delivery path, which causes anaccumulation of at least one substance along the delivery path, thesubstance impeding subsequent passage of the laser energy. For example,the substance that accumulates may comprise ozone, since passage of thelaser energy along the delivery path typically causes an amount ofoxygen (O₂) to be converted to ozone (O₃). Alternatively oradditionally, the method may calculate a decrease in delivered energybased on accumulation of any other substance(s) along the laser energydelivery path. In some embodiments, calculating the decrease in theamount of delivered energy comprises calculating a decrease in deliveredenergy of a pulse of laser energy compared to an immediately previouslyfired pulse of laser energy. For example, calculating the decrease mayinvolve calculating an amount of decrease caused by accumulation of oneor more substances in the delivery path of the laser energy and reducingthe amount of the decrease caused by the accumulation by a factor oftime between pulses of the laser energy, which time allows fordissipation of the substance(s).

Adjusting the laser generating device, in some embodiments, comprisesincreasing an amount of laser energy provided from the laser generatingdevice over time to compensate for accumulation of at least onesubstance along a delivery path of the laser energy caused by passage ofthe laser energy along the path. Again, the substance may be ozoneand/or any other substance. In some embodiments, adjusting the lasergenerating device also involves reducing any increases in the amount ofprovided laser energy to compensate for time between pulses of laserenergy, which time allows for dissipation of the substance(s).

Typically, though not necessarily, the measuring, calculating andadjusting steps of the method are performed during a calibrationprocedure for the laser generating device. A laser may thus becalibrated before performing a laser eye surgery procedure, and thelaser may then be used for multiple procedures without recalibration. Insome embodiments, the method also includes directing laser energy,either pulsed or constant wave, from the laser generating device towardthe target. Some embodiments may also include performing a laser eyesurgery procedure with the laser generating device after the calibrationprocedure.

In another aspect of the present invention, a method for performing alaser eye surgery procedure comprises calibrating a laser generatingdevice and performing the laser eye surgery procedure using thecalibrated laser generating device. Calibrating the laser generatingdevice comprises: measuring the amount of delivered laser energyarriving at or near a target from the laser generating device over aperiod of time; calculating a decrease in the amount of delivered energyover time; and adjusting the laser generating device to compensate forthe decrease so that the delivered laser energy arriving at the targetremains approximately constant over time.

In another aspect of the invention, a method for performing a laser eyesurgery procedure includes directing an amount of laser energy from alaser generating device toward an eye and adjusting the amount ofdirected laser energy to compensate for accumulation of one or moresubstances along a delivery path of the laser energy to stabilize theamount of delivered laser energy that arrives at the eye. As mentioned,typically the amount of directed laser energy is adjusted to compensatefor accumulation of ozone along the delivery path, although it mayalternatively or additionally be adjusted to compensate for accumulationof any other substance(s). In some embodiments, the amount of directedlaser energy is increased over time to compensate for accumulation ofozone along the delivery path and is decreased over time to compensatefor time between pulses of the laser energy, which time allows the ozoneto dissipate.

In another aspect of the present invention, a system for performing alaser eye surgery procedure comprises: a laser energy generating device;a laser energy measuring device disposed at or near a target formeasuring delivered energy of the laser energy device; and a processorcoupled with the laser energy generating device and the laser energymeasuring device. The processor is generally for calculating anadjustment to the laser energy generating device to compensate foraccumulation of one or more substances along a laser energy deliverypath and for adjusting the laser energy generating device to stabilizean amount of delivered laser energy that arrives at a target of thelaser eye surgery procedure.

In various embodiments, the laser energy generating device may provideeither pulsed laser energy, constant wave laser energy, or both. In someembodiments, as mentioned above, the processor is calibrated beforeperforming the laser eye surgery procedure. Also in some embodiments,the processor increases an amount of laser energy provided by the laserenergy device to compensate for the accumulation of the substance(s) anddecreases the provided laser energy to compensate for time betweenpulses of the laser energy, which time allows for dissipation of thesubstance(s). Again, the system typically compensates for accumulationof ozone along the delivery path.

In yet another aspect of the present invention, a system for performinga laser eye surgery procedure includes a laser energy generating deviceand a processor coupled with the laser energy generating device forcalculating an adjustment to the laser energy generating device tocompensate for accumulation of one or more substances along a laserenergy delivery path and for adjusting the laser energy generatingdevice to stabilize an amount of delivered laser energy that arrives ata target of the laser eye surgery procedure. The processor is calibratedbefore performing the laser eye surgery procedure.

These and other aspects and embodiments of the invention are describedin detail below, in reference to the attached drawing figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a laser ablation system forincorporating the present invention.

FIG. 2 schematically illustrates a laser beam delivery system forselectively directing a laser beam onto a corneal tissue according to anembodiment of the present invention.

FIG. 3 is a functional block diagram illustrating a control architectureof an ablation system as in FIG. 1 according to an embodiment of thepresent invention.

FIG. 4 is a flow chart describing a method for calibrating a laserdevice according to one embodiment of the present invention.

FIG. 5 is a flow chart describing another method for calibrating a laserdevice according to an embodiment of the present invention.

FIG. 6 is a flow chart describing a method for adjusting a laser deviceto stabilize delivered energy according to one embodiment of the presentinvention.

DETAILED DESCRIPTION OF THE INVENTION

The present invention is particularly useful for enhancing the accuracyand efficacy of laser eye surgical procedures, such as photorefractivekeratectomy (PRK), phototherapeutic keratectomy (PTK), laser assisted insitu keratomileusis (LASIK), laser epithelial keratomileusis (LASEK) andthe like. Preferably, the present invention can provide enhanced opticalaccuracy of refractive procedures by improving a corneal ablation of arefractive treatment program. While systems and methods of the presentinvention are described primarily in a context of a laser eye surgerysystem, techniques of the present invention may also be adapted for usein alternative eye treatment procedures and systems such as ablatableintraocular lenses, contact lenses, and the like. Additionally, systemsand methods of the invention may be used in contexts outside of lasereye surgery for enhancing any laser device used for any purpose.

The techniques of the present invention can be readily adapted for usewith existing laser systems. By helping stabilize an amount of laserenergy delivered to a patient's eye, the present invention mayfacilitate sculpting of the cornea so that treated eyes regularly exceeda normal 20/20 threshold of desired vision.

Referring now to FIG. 1, a laser eye surgery system 10 for incorporatingthe present invention includes a laser 12 that produces a laser beam 14.Laser delivery optics 16 are in a path of laser beam 14. Delivery optics16 direct laser beam 14 to an eye of a patient P. A delivery opticssupport structure (not shown here for clarity) extends from a frame 18supporting laser 12. An input device 20 is used to align laser system 10in relation to an eye of a patient P. A microscope 21 is mounted on thedelivery optics support structure, the microscope often being used toimage a cornea of an eye. In various embodiments, a laser eye surgerysystem 10 includes at least some portions of a Star S4 Active Trak®Excimer Laser System available from VISX, INCORPORATED of Santa Clara,Calif.

While an input device 20 is here schematically illustrated as ajoystick, a variety of input components may be used. Suitable inputcomponents may include trackballs, touch screens, or a wide variety ofalternative pointing devices. Still further alternative input componentsinclude keypads, data transmission mechanisms such as an Ethernet,intranet, Internet, a modem, or the like.

A laser 12 generally comprises an excimer laser and ideally comprises anargon-fluoride laser producing pulses of laser light having a wavelengthof approximately 193 nm. A pulse of laser light typically has a fixedpulse duration having a full width half maximum (FWHM) of about 15nanoseconds during a treatment. Laser 12 is preferably designed toprovide a feedback stabilized fluence at the patient's eye, deliveredvia delivery optics 16. The present invention may also be useful withalternative sources of electromagnetic radiation, particularly thoseadapted to controllably ablate a corneal tissue without causingsignificant damage to adjacent and/or underlying tissues of the eye. Thelaser system may include, but is not limited to, excimer lasers such asargon-fluoride excimer lasers (producing laser energy with a wavelengthof about 193 nm), solid state lasers, including frequency multipliedsolid state lasers such as flash-lamp and diode pumped solid statelasers. Exemplary solid state lasers include UV solid state lasers(approximately 193-215 nm) such as those described in U.S. Pat. Nos.5,144,630 and 5,742,626. Laser energy may comprise a beam formed as aseries of discreet laser pulses. A variety of alternative lasers mightalso be used. Hence, although an excimer laser is the illustrativesource of an ablating beam, other lasers may be used in the presentinvention.

Laser 12 and delivery optics 16 will generally direct laser beam 14 toan eye of patient P under direction of a processor 22. Processor 22 willoften selectively adjust laser beam 14 to expose portions of the corneato pulses of laser energy so as to effect a predetermined sculpting of acornea and alter refractive characteristics of an eye. In manyembodiments, both laser 14 and a laser delivery optical system 16 willbe under computer control of processor 22 to effect a desired lasersculpting process, with processor 22 effecting (and optionallymodifying) a pattern of laser pulses. A pattern of pulses may bysummarized in a treatment table listing of machine readable data of atangible media 29. A treatment table may be adjusted according tofeedback input into processor 22 from an automated image analysis system(manually input into processor 22 by a system operator) in response tofeedback data provided from an ablation monitoring system feedbacksystem. Such feedback might be provided by integrating a wavefrontmeasurement system described below with a laser treatment system 10, andprocessor 22 may continue and/or terminate a sculpting treatment inresponse to feedback, and may optionally also modify a planned sculptingbased at least in part on feedback.

Laser beam 14 may be adjusted to produce a desired sculpting using avariety of alternative mechanisms. A laser beam 14 may be selectivelylimited using one or more variable apertures. An exemplary variableaperture system having a variable iris and a variable width slit isdescribed in U.S. Pat. No. 5,713,892, the full disclosure of which isincorporated herein by reference. A laser beam may also be tailored byvarying a size and offset of a laser spot from an axis of an eye, asdescribed in U.S. Pat. No. 5,683,379, and as also described inco-pending U.S. patent application Ser. No. 08/968,380, filed Nov. 12,1997; and 09/274,999 filed Mar. 22, 1999, the full disclosures of whichare incorporated herein by reference.

Still further alternatives are possible, including scanning a laser beamover a surface of an eye and controlling a number of pulses and/or dwelltime at each location, as described, for example, by U.S. Pat. No.4,665,913 (the full disclosure of which is incorporated herein byreference) and laser systems by Alcon, Bausch & Lomb, Wavelight and thelike; using masks in an optical path of laser beam 14 which ablate tovary a profile of a beam incident on a cornea, as described in U.S.patent application Ser. No. 08/468,898, filed Jun. 6, 1995 (the fulldisclosure of which is incorporated herein by reference); hybridprofile-scanning systems in which a variable size beam (typicallycontrolled by a variable width slit and/or variable diameter irisdiaphragm) is scanned across the cornea as described in U.S. Pat. Nos.6,319,247; 6,280,435; and 6,203,539, the full disclosures of which areincorporated herein by reference; or the like. The computer programs andcontrol methodology for these laser pattern tailoring techniques arewell described in the patent literature.

Additional components and subsystems may be included with laser system10, as should be understood by those of skill in the art. For example,spatial and/or temporal integrators may be included to control thedistribution of energy within the laser beam, as described in U.S. Pat.Nos. 5,646,791 and 5,912,779 the full disclosures of which areincorporated herein by reference. An ablation effluent evacuator/filter,and other ancillary components of the laser surgery system which are notnecessary to an understanding of the invention, which may be optionallyemployed, need not be described in detail for an understanding of thepresent invention.

Processor 22 may comprise (or interface with) a conventional PC systemincluding standard user interface devices such as a keyboard, a displaymonitor, and the like. Processor 22 will typically include an inputdevice such as a magnetic or optical disk drive, an internet connection,or the like. Such input devices will often be used to download acomputer executable code from a tangible storage media 29 embodying anymethods of the present invention. Tangible storage media 29 may comprisea floppy disk, an optical disk, a data tape, a volatile or non-volatilememory, or the like, and a processor 22 will include memory boards andother standard components of modern computer systems for storing andexecuting a computer program code. Tangible storage media 29 mayoptionally embody wavefront sensor data, wavefront gradients, awavefront elevation map, a treatment map, a corneal topography map, ameasurement of a refraction of an eye, an ablation table, and/orinstructions to adjust the amount of energy.

Referring now to FIG. 2, a laser beam delivery system 16 for directing alaser beam 14 at an eye E will often include a number of mirrors 30, aswell as one or more temporal integrators 32 which may adjust (orotherwise tailor) an energy distribution across a laser beam. Laser 12will often comprise an excimer laser as described above.

In an exemplary embodiment, a variable aperture 34 changes a diameterand/or slit width to profile laser beam 14, ideally including both avariable diameter iris and a variable width slit. A prism 36 separateslaser beam 14 into a plurality of beamlets, which may partially overlapon eye 2 to smooth edges of an ablation or “crater” formed from eachpulse of a laser beam. An offset module 38 includes motors which vary anangular offset of an offset lens, and which also change a radialorientation of an offset. Hence, offset module 38 can selectively directlaser beam 14 at a desired lateral region of a cornea. A structure andmethod for using a laser beam delivery system 16 and an offset module 38are more fully described in U.S. Pat. Nos. 6,331,177; 6,203,539;5,912,775; and 5,646,791 the full disclosures of which are incorporatedherein by reference.

In some embodiments, laser beam delivery system 16 includes a deliveredenergy measurement device 33 for measuring the amount of laser beamenergy delivered to the eye E. For example, mirror 30 may be asemi-translucent mirror, lens or the like, to allow some amount of laserbeam 14 to pass through. In many cases, measurement device 33 is usedbefore laser beam 14 is ever applied to an eye E. For example, asequence of test pulses of laser beam is often fired at a targetpositioned in the same location that the eye E will be positioned duringa laser eye surgery procedure. When the sequence of test pulses isfired, measurement device 33 measures the amount of energy delivered tothe patient with each pulse during the sequence. These measurements maythen be used to calculate a decrease in delivered energy of laser pulsescaused by accumulation of one or more substances, such as ozone, alongthe delivery path of laser beam 14. Measurement device 33 may also beused to measure delivered laser energy of a constant wave laser beam,which measurements may be used to calculate a decrease in energy of thebeam over time. In some embodiments, measurements of delivered energyare taken, calculations are made, and laser 12 is adjusted or calibratedbefore a laser eye surgery is performed so as to provide stabilizeddelivered laser energy to eyes during laser eye surgery procedures.

The “delivery path” of laser beam 14 is depicted in FIG. 2 by the linelabeled as laser beam 14. Delivery path is referred to generally in thisapplication as any path along which a laser beam may travel from a laserbeam generating device to a target. Thus, the present invention is notlimited to any particular form of delivery path. Systems and methods ofthe invention may be used to stabilize delivered laser energy travelingalong any suitable delivery path.

Referring now to FIG. 3, a control system of a laser system 10 isschematically illustrated according to principles of the presentinvention. A processor 22 enables precise control of laser system 10 tosculpt a surface shape according to a laser treatment table 52. Aprocessor 22, which generally comprises a PC workstation, makes use of acomputer program stored on a tangible media 29 to generate treatmenttable 52, as described in U.S. Pat. No. 6,673,062, the full disclosureof which is incorporated herein by reference. Processor 22 includes alibrary 44 of treatments as described in U.S. Pat. Nos. 6,673,062(previously incorporated by reference) and 6,245,059, the fulldisclosure of which is incorporated herein by reference. An embeddedcomputer 58 within laser system 10 is in electronic communication withthe PC workstation. Alternatively, a PC workstation may be embedded inlaser system 10 and include an embedded processor card in communicationwith a PC workstation for directing an ophthalmic surgery.

Embedded computer 58 is in electronic communication with a plurality ofsensors 56 and a plurality of motor drivers 60. Motor drivers 60 arecoupled to an embedded computer 58 to vary a position and configurationof many of optical components of delivery optics 16 according totreatment table 52. For example, first and second scanning axes 62, 64control a position of an offset lens to move several laser beamlets overa surface of a cornea. Iris motor 66 controls an overall diameter of abeam, and in some cases, a length of light transmitted through avariable width slit. Similarly a slit width driver 68 controls a widthof a variable slit. Slit angle driver 70 controls rotation of a slitabout its axis. Beam angle driver 72 controls beam rotation as effectedby a temporal integrator as described above. A timer 80 controls a timeinterval between pulses of a laser treatment. Timer 80 measures a timeinterval from a previous pulse and generates an interrupt after apredetermined time interval has elapsed. Processor 22 issues a commandfor laser 12 to generate a pulse of laser beam 14 after various opticalelements have been positioned to create a desired crater on eye E andafter a measured time interval has elapsed. Treatment table 52 comprisesa listing of all desired craters to be combined so as to effect atreatment therapy.

In various embodiments of the present invention, processor 22 may beused to calculate decreases in amounts of delivered laser energy to atarget, to calculate adjustments in amounts of dispatched energy tocompensate for the decreases in delivered energy, to provide informationto laser 12 to compensate for the decreases, and/or the like. In someembodiments, a computer program stored on tangible medium 29 may be usedby processor to make calculations and/or compensate for decreases indelivered energy. Methods for calculating delivered energy decreases,calculating compensatory increases, and adjusting a laser generatingdevice are described in greater detail below.

In one aspect of the present invention, a method for stabilizingdelivered laser energy involves measuring delivered laser energy overmultiple laser pulses (or during a period of time, in the case of aconstant wave laser), calculating a decrease in delivered energy causedby accumulation of one or more substances, such as ozone, along thelaser delivery path, and adjusting a laser to compensate for thedecrease. Various embodiments of such a method may include firing anumber of laser pulses, measuring the pulses and using the measurementsto calculate decreases in delivered energy, compensatory increases indispatched energy and/or the like. As mentioned above, such a method maybe used to calibrate a laser before performing laser eye surgeryprocedures. In some embodiments, one calibration of a laser generatingdevice will be sufficient to calibrate the laser device for many lasereye surgery procedures.

Referring now to FIG. 4, a flow diagram of one calibration method 100for calibrating a laser device is described. The calibration method 100generally includes firing a first laser pulse 102, measuring the energyof the laser pulse at or near a target of the laser 104, and storing themeasurement data from that pulse 106. If a desired number of pulses hasbeen fired 112, then the method proceeds to a calculating step 114.Otherwise 110, another laser pulse is fired 102, and delivered energy ismeasured 104 and stored 106. After a desired number of pulses has beenfired 112, one or more calculations is performed 114. Such calculationsinclude, for example, determining how much decrease in delivered energyoccurs between laser pulses. In other words, one calculation may be anamount of decrease in energy that occurs in a given laser pulse as aresult of accumulated substance(s), such as ozone, along the laser beamdelivery path caused by the immediately preceding laser pulse. Anothercalculation may be an amount of dissipation of ozone (or otheraccumulated materials) that occurs during time delays between laserpulses. Generally, time between pulses, which allows ozone to dissipate,will decrease the effects of the accumulated ozone caused by prior laserpulses. From one or more initial calculations 114, one or moreadjustments may be calculated 116 for use in programming or adjusting alaser energy generating device to compensate for the decrease indelivered laser energy at the target due to the accumulated ozone and/orother substances along the delivery path. Typically, this adjustmentinvolves gradually increasing the energy of the laser beam provided bythe laser device over time to compensate for the accumulated substances.As has been mentioned above, the method just described may be usedequally well with a constant wave laser.

To compensate for the gradual build-up of ozone and/or other substancesalong a laser energy delivery path, the laser energy that is provided by(i.e., that leaves or is “dispatched from”) the laser device isincreased by a factor calculated from the predicted reduction indelivered energy. Each fired laser pulse will reduce the energydelivered by subsequent pulses by an amount, P. Counteracting thisreduction in delivered energy is an increase in delivered energy causedby dissipation of ozone that occurs between laser pulses. Thiscounteracting increase is described by the equation C×(E₀−E)×Δt, where Cis a diffusion constant, E₀ is the amount of energy delivered in theabsence of ozone, E is the amount of delivered energy, and Δt is thetime interval between two laser pulses. Values for P and C may becalculated during a calibration procedure, as described above, and thosevalues may then be used in one or more calculations to compensate fordecreases in delivered energy of the laser device.

Referring now to FIG. 5, one embodiment of a calibration method 120 isdescribed. In this embodiment, a laser pulse is fired 122, for examplehaving an energy as close as possible to an energy that will be used fortreatment of an eye. In one embodiment, this amount of energy may bedetermined from a most recent calibration coupled with a fluence checkrun shortly before the calibration. When the pulse is fired 122, a pulsecounter counts the pulse 124, delivered energy data is measured andstored 126, and the system then asks if 1000 or fewer pulses have beenfired 128. If yes 130, then a 50 millisecond delay occurs 132 andanother laser pulse is fired 122. This process continues until 1000pulses have been fired 136. At that point the system asks whether 4 orfewer repeats of 1000 pulses have been fired 138. If yes 140, then a oneminute delay occurs 134, and another sequence of 1000 pulses is firedand measured. After 4 series of 1000 pulses are fired and measured 142,average energy for each time (t) is determined 144. The four data setswill be averaged to produce a single set of data. A single exponentialwill then be fit to this data 146. In one embodiment, the first 20 datapoints will not be used in the fit. The parameters C and P can then beeasily extracted from the fit parameters 148. A look-up table may thenbe generated from C and P 148. This look-up table may then be used toinstruct a laser device to provide a desired amount of energy in aseries of laser pulses. Again, this is only one embodiment of a methodfor calibrating a laser device, and many variations may be made to suchan embodiment without departing from the scope of the invention.

Once information is gathered during a calibration procedure, thisinformation may be used to calibrate a laser. In other words, variousmethods of the invention provide for adjusting a laser device during alaser eye surgery procedure to stabilize the amount of laser energydelivered to the target—i.e., a patient's eye. Basically, the laserdevice is adjusted according to information gathered and calculatedduring the calibration procedure. In some embodiments, for example, thevariables P and C are determined during calibration and these variablesare then used in an equation during a laser eye surgery procedure toadjust the amount of laser energy provided by the laser device so as tostabilize delivered energy.

Referring now to FIG. 6, one exemplary method 150 for firing a laser ina laser eye surgery procedure is shown. In this embodiment, a command tofire the laser is received 152, for example by a processor couple withthe laser. Next, a value of E₀ is obtained 154. E₀ is constant, and isgenerally the desired amount of energy fired by the laser on the firstpulse. The value of E is also obtained 154. E is equal to E₀ for thefirst pulse but then changes with each subsequent pulse. E is the valueof the target energy fired by the laser on each pulse, and this amountgenerally increases gradually during a treatment to compensate foraccumulated ozone and/or other substances along the laser beam deliverypath. The time since the last pulse was fired (t) is also obtained 154at this stage. The system then asks whether t is less than approximatelyone second 156. If yes 160, then the system uses the equationE _(new) =E _(old) −P+Ct(E ₀ −E _(old))to determine the amount of energy at which to target the next laserpulse 161. E_(new) is the amount of energy at which the next laser pulsewill be targeted. E_(old) is the amount of energy at which the lastlaser pulse was targeted. P is the amount of energy by which one laserpulse decreases the delivered energy of the next subsequent laser pulse.C is a diffusion constant, and t is the time delay between two laserpulses.

In some embodiments, once E_(new) is determined, it may be checkedagainst specified limits 164, such as a minimum and maximum valuerelated to E₀. In one embodiment, for example, E_(new) must be greaterthan 0.85*E₀ and less that 1.01*E₀ for the laser to fire 168, 172. IfE_(new) does not fall within this threshold 166, then the laser does notfire, and instead a warning is provided to the user 170. Of course, thisthreshold check is optional, and any other threshold may be used.

In some embodiments, when t is greater than or equal to one second 158,the equation immediately above is not used to calculate the energy ofthe next laser pulse. Treatment interruptions of 1 second or greater mayrequire an alternative calculation to be performed, predominantly due tothe fact that such interruptions allow accumulated substances along thelaser beam delivery path, such as ozone, to dissipate, thus renderingthe equation explained above inapplicable. For example, in oneembodiment, when t is greater than or equal to 1 second 158, then thesystem looks up the change in the energy of the next pulse from a table.This amount of energy of the next pulse may be referred to as the“target energy,” in that it is the energy that is desired to be achievedfrom the laser device. Target energy, therefore is synonymous with“dispatched energy” or the other similar terms explained above. In oneembodiment, a look-up table used when t is greater than or equal to 1second uses the formulaE _(new) =E ₀(1−e ^(−Ct))+E _(old) e ^(−Ct)to calculate E_(new). In one embodiment, for example, the table mayconsist of 59 values corresponding to delays between 1 second and 60seconds. Each value will be calculated by putting the time plus 0.5second into the formula above, i.e. 1.5 seconds, 2.5 seconds, 3.5seconds and so on, so that, for instance, a pause of between 23.00 and23.99 seconds will use the value calculated in the table for 23.5seconds. The calculation will be made by the laser central processingunit immediately after the command is sent by the main computer to fire(i.e. immediately before charging). The time required to perform thecalculation should be negligible in comparison to the 5 milliseconddelay between the command being received and the laser firing.

While the above provides a complete and accurate description of specificembodiments of the invention, several changes and adaptations of thepresent invention may be readily made. For example, while specificreference has been made to calibration of laser devices for use in lasereye surgery, any other suitable laser device may be calibrated usingmethods and systems of the present invention. In fact, since many if notall laser beams will cause an accumulation of ozone along the deliverypath of the beam, systems and methods of the invention may enhance theaccuracy and utility of any number of different laser devices andsystems. Additionally, various embodiments of the invention mayalternatively be used to enhance delivery of any beam(s) ofelectromagnetic radiation, and are thus not limited to use with lasers.Therefore, the above description is provided for exemplary purposes onlyand should not be interpreted to limit the scope of the invention as itis defined in the following claims.

1. A system for performing a laser eye surgery procedure, the systemcomprising: a laser energy generating device; a laser energy measuringdevice disposed at or near a target for measuring delivered energy ofthe laser energy device; and a processor coupled with the laser energygenerating device and the laser energy measuring device for calculatingan adjustment to the laser energy generating device to compensate foraccumulation of one or more substances along a laser energy deliverypath and for adjusting the laser energy generating device to stabilizean amount of delivered laser energy that arrives at a target of thelaser eye surgery procedure.
 2. A system as in claim 1, wherein thelaser energy generating device provides pulsed laser energy.
 3. A systemas in claim 1, wherein the laser energy generating device providesconstant wave laser energy.
 4. A system as in claim 1, wherein theprocessor is calibrated before performing the laser eye surgeryprocedure.
 5. A system as in claim 1, wherein the processor increases anamount of laser energy provided by the laser energy device to compensatefor the accumulation of the substance(s) and decreases the providedlaser energy to compensate for time between pulses of the laser energy,which time allows for dissipation of the substance(s).
 6. A system as inclaim 1, wherein the processor adjusts the laser energy generatingdevice to compensate for accumulation of ozone along the delivery path.